Ethics of conflicts of interest in medical authorship
Authors: Sonal Muzumdar, Jane M. Grant-Kels
Journal: Journal of the American Academy of Dermatology (2023)

Dear Dr Dermatoethicist: I regularly coauthor a requested chapter about melanoma in pregnancy for a well-known reference website. I have no conflicts of interest (COIs) regarding this topic but recently received stock and a stipend for my medical advice to assist a company exploring artificial intelligence for the diagnosis of melanoma and non-melanoma skin cancers. This year, after submitting the updated version of my chapter, I was notified that I would have to step down as coauthor due to my involvement in this new company despite the fact thatthe manuscript made no mention of artificial intelligence or any other new technology available to assist in the diagnosis of melanoma. When I challenged this, my article was removed altogether and then ultimately published without my name as a co-author. How can we ethically manage COIs in medicine?—Conflicted Author Dear Dr Dermatoethicist: I regularly coauthor a requested chapter about melanoma in pregnancy for a well-known reference website. I have no conflicts of interest (COIs) regarding this topic but recently received stock and a stipend for my medical advice to assist a company exploring artificial intelligence for the diagnosis of melanoma and non-melanoma skin cancers. This year, after submitting the updated version of my chapter, I was notified that I would have to step down as coauthor due to my involvement in this new company despite the fact thatthe manuscript made no mention of artificial intelligence or any other new technology available to assist in the diagnosis of melanoma. When I challenged this, my article was removed altogether and then ultimately published without my name as a co-author. How can we ethically manage COIs in medicine? —Conflicted Author Dear Conflicted: Conflicts of interest, pervasive in medicine,1Steinbrook R. Controlling conflict of interest--proposals from the Institute of Medicine.N Engl J Med. 2009; 360: 2160-2163https://doi.org/10.1056/NEJMp0810200Crossref PubMed Scopus (98) Google Scholar,2Garattini L. Padula A. Mannucci P.M. Conflicts of interest in medicine: a never-ending story.Intern Emerg Med. 2020; 15: 357-359https://doi.org/10.1007/s11739-020-02 293-4Crossref PubMed Google Scholar occur when professional judgment about a primary issue is influenced by a secondary interest, as financial gain or career advancement.2Garattini L. Padula A. Mannucci P.M. Conflicts of interest in medicine: a never-ending story.Intern Emerg Med. 2020; 15: 357-359https://doi.org/10.1007/s11739-020-02 293-4Crossref PubMed Google Scholar,3Thompson D.F. Understanding financial conflicts of interest.N Engl J Med. 1993; 329: 573-576https://doi.org/10.1056/NEJM199308193290812Crossref PubMed Scopus (654) Google Scholar In this scenario, the author's primary interest to provide education about melanoma in pregnancy was perceived to have been influenced by her financial interest in a new company. It is important to assess how likely a potential COI is to impact professional judgment.4Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and PracticeLo B. Field M.J. Conflict of Interest in Medical Research, Education, and Practice. National Academies Press (US), 2009Google Scholar This may be accomplished by full disclosure of COIs by authors, and evaluation by both readers and impartial third-party experts employed by journals. Additionally, it is important to assess the harm a COI may cause.4Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and PracticeLo B. Field M.J. Conflict of Interest in Medical Research, Education, and Practice. National Academies Press (US), 2009Google Scholar Readers may assess this by considering (1) how an author's COI may impact their recommendations on a topic and (2) the magnitude of harm likely to result if COI altered authors' integrity. COIs are difficult to eliminate, but steps may be taken to mitigate their impact on medical literature. First, authors should voluntarily report all potential COIs and how they may impact their work.1Steinbrook R. Controlling conflict of interest--proposals from the Institute of Medicine.N Engl J Med. 2009; 360: 2160-2163https://doi.org/10.1056/NEJMp0810200Crossref PubMed Scopus (98) Google Scholar Second, in concordance with the Committee on Publication Ethics, editors should have a standardized process by which to evaluate potential COIs that they disclose to authors prior to article submission.5General Approach to Publication Ethics for the Editorial Office. Committee on Publication Ethics, 2018Google Scholar Having impartial committees of members with expertise but no COIs themselves may facilitate this process.1Steinbrook R. Controlling conflict of interest--proposals from the Institute of Medicine.N Engl J Med. 2009; 360: 2160-2163https://doi.org/10.1056/NEJMp0810200Crossref PubMed Scopus (98) Google Scholar Finally, to the best of their abilities, journals, editorial boards, and accreditation organizations like the Accreditation Council for Continuing Medical Education should have third-party experts ethically evaluate and adjudicate articles and lectures for authentic and relevant COIs to further mitigate their impact on the scientific literature while preserving the ethical rights of the "expert" to participate in sharing of information. Although what the publisher did in this scenario may be contractually sound, it is not necessarily ethical. The publisher's decision has the potential to deprive readers of expert opinion and the authors of just and fair treatment. Although their action may conform to the letter of the author contract, experts are often conflicted and should not be silenced unless the conflict is relevant, hidden, and/or could result in bias. Similarly, publishing an article without crediting all involved authors is unethical as it prevents authors from getting appropriate recognition for their work. —Dr Dermatoethicist Dr Grant-Kels is an investor and part owner for VeraDermics and owns stocks and receives salary for medical advice from DermaSensor. Dr Muzumdar has no conflicts of interest to declare.